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Exploring Critical Success for Telehealth Implementation
Session #84, February 12
th
, 2019
Doris Barta, MHA - Director; Kathy Chorba – Executive Director; Jonathan Neufeld, PhD – Program Director
The National Consortium of Telehealth Resource Centers
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Doris Barta, MHA – Executive Director, TTAC
Kathy Chorba – Executive Director, CTRC
Jonathan Neufeld, PhD – Executive Director, gpTRAC
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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1. Brief overview of the National Consortium of Telehealth
Resource Centers
2. Critical success factors within each of the five elements of the
Telehealth Implementation Roadmap
a) Assess
b) Establish
c) Define
d) Implement
e) Improve
3. Free resources and technical assistance available for program
development, implementation and sustainability
4. Q&A
Agenda
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1) Gain an understanding of the five critical steps for telehealth
program design.
2) Acquire insights into the distinct leadership roles required of
telehealth operations, technology, clinical services, and business
sustainability staff and managers.
3) Develop an awareness of the benefits and challenges related to
leadership integration.
Learning Objectives
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Great
Ideas
Where
do I
start?
Telemedicine …
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Planning, implementation and
integration requires a multidisciplinary
team to be involved throughout each
phase of the project.
On the following slides, look to the left
for team category suggestions!
Clinical
* Technology *
Operations
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Assess
Clinical and Administrative
Service Needs
Leadership Support
Clinical Provider Buy-in
Relationships with
Specialty Providers
Technology Infrastructure
and Equipment Inventory
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• Unmet healthcare needs
– Specialties
– Volume
• Current telehealth
experience
• Other uses for telehealth
equipment?
– Medical interpreting
services
– Administrative meetings
– Continuing medical
education
Operations
Needs Assessment: Clinical
and Administrative Services
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• Tele-communications
– Secure, medical grade broadband in the staff
meeting and clinic exam rooms? Is it wired or
wireless?
• Equipment and peripherals
– Videoconferencing equipment
– Peripherals (exam camera, stethoscope,
otoscope)
– Computer with webcam, microphone,
speakers
– Store and forward software, digital camera
Technology
Existing Technology
Infrastructure and Equipment
Inventory
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• Program financing
– Grant funding? For what, how much and how
long?
– Institutional funding commitment
• Staffing allocation
– Program design, management and day to day
operations
• Ongoing program support
– Staffing, technology, change management
Operations
Leadership Support
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• Understand the value of telehealth to
patients and clinical practice
• Recognize needs that could be addressed
• Willing to incorporate telehealth into daily
practice
– Patient identification and referral
– Patient presentation and follow-up
• Understand the basic procedures (enough to
not veto the effort)
Clinical
Clinical Provider Buy-in
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• In-house
– Within your organization, practicing at a different
location
• In the community
– Providers in your referral network that would
benefit from enhanced services provided via
telemedicine
• Statewide / National Resources
– Telemedicine providers carry lots of licenses
Clinical
Existing and Potential
Relationships with
Specialty Providers
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Establish
Telehealth Team
Specialty Service
Provider Partnerships
Technology Infrastructure
Revenue Cycle
Management Program
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Operations
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20 questions to consider asking a specialty service
provider prior to signing the contract
• Finding telehealth specialty service providers is not
as difficult as it has been in the past.
• The challenge is to find those that will meet the
unique needs and requirements of your clinic
organization
• Each provider and clinic organization will have
similarities and differences in practice and business
models as they pertain to providing healthcare via
telemedicine
Operations
Specialty Service
Provider Partnerships
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Operations
Specialty Service
Provider Partnerships
1. Specialties available
2. Payment model
3. Rates
4. Appointment times
5. Credentialing policy
6. Specialist qualifications
7. Established referral
guidelines
8. Staffing requirements
9. Direct patient care or
consultation only
10. Medication refills
11. Specialist continuity
12. Turn around time for chart
notes
13. Cancellation/no show policy
14. Patient double-booking
15. Back up plan for tech failure
16. Technical support available
17. Non-consult communication
18. Method of communication
during consult
19. Post-consult correspondence
20. Onboarding process
20 Question Topics to Consider
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Operations
Specialty Service
Provider Partnerships
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• Technology requirements of the specialty
provider for teleconsults
– Hardware, software, peripheral devices
• Proprietary or standards based?
• Cloud access or point to point?
– Requirements for transmitting patient
information
– Electronic health record access
Technology
Technology Infrastructure
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• Equipment and peripherals
• To accomplish the administrative and clinical
service goals established by the needs
assessment and specified by the specialty
consultant
• Secure medical grade broadband to clinic and
conference rooms
• Sufficient to support the equipment and/or
software
Technology
Technology Infrastructure
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• Payer credentialing and contracting
– Research and understand your payer
environment
– Develop payer reimbursement chart indicating for
each major payer if they reimburse and which
codes to submit
• Financial modeling and Pro Formas
– Forecasting cost of program is critical for
sustainability
– Create a pro forma that estimates the monthly
cost of the program over the first year as both
utilization and payer reimbursements mature
Operations
Revenue Cycle
Management Program
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Operations
Revenue Cycle
Management Program
• Key pro forma data points
– Payer mix of patient population served
– Anticipated volume by specialty
– Estimated payer reimbursement
– Physician compensation and service fees
– Technology platform and recurring infrastructure
costs
– Staffing costs
– Related financial benefits to the facility
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Operations
Specialty Service
Provider Partnerships
Quiz:
When paying a specialty service provider by the hour,
when is the $250/hr specialist less expensive than the
$200/hr specialist?
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Operations
Specialty Service
Provider Partnerships
Quiz:
When paying a specialty service provider by the hour,
when is the $250/hr specialist less expensive than the
$200/hr specialist?
Answer: When the $250/hr specialist can fit more
patient visits into each hour.
Provider A: $250/hr Initial 40, and f/u 20 ($250)
Provider B: $200/hr Initial 60, and f/u 30 ($300)
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Operations
Specialty Service
Provider Partnerships
Appointment type: time (min)
# of visits
total hours
Initial 40 4 2.67
Established 20 4 1.33
Total number of visits per block of time purchased 8 4.00
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225.00$
900.00$
165.00$
1,320.00$
15%
1,122.00$
10%
1,009.80$
20.00$
80.00$
29.80$
This worksheet is provided as a basic tool to assist in business model development and
is based on the model of purchasing a 4 hour block of time
CTRC Sample Telehealth Sustainability Worksheet
Instructions: Insert your data in to the blue cells. All remaining cells will be automatically
populated based on the information entered.
Note: This calculation does not include sliding fee collection
Patient Volume
Specialist hourly rate
Specialty cost per block of time reserved
Clinic collection rate per encounter (PPS rate)
Amount clinic collects if 100% billable
Average No Show rate for clinic (or specialty)
Clinic collection minus No Show rate
Clinic uninsured rate
Adjusted clinic collection minus No Show rate
Staffing and overhead per hour
Staffing and overhead per block of time purchased
For more information or assistance with this spreadsheet, please contact the CTRC at
www.caltrc.org
Variance
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Specialty Service Provider Relationships:
Advantages and Disadvantages of the Most Common Contracting Models
Model
Advantage
Disadvantage
Originating site purchases
blocks of time from distant
site
Originating Site
: Guaranteed access to
specialist
Originating Site:
Risk assumed for no-show
patients
Distant Site
: Guaranteed payment for time
reserved
Originating site pays per
patient seen
Originating Site
: No pressure to fill blocks of
time
Originating Site
: Possible excessive wait time
for appointment
Distant Site: Difficult to forecast volume to plan
for coverage. AND
Assume risk for no
-show patients
Originating site pays the
delta between distant site’s
cost and collections
Originating Site
: Only pays a portion of the
specialty visit cost
Distant Site
: Assumes the administrative cost
& burden of billing patient insurance & balance
billing originating site
Health Plan contracts
directly with specialty
service provider
Originating Site: Most sustainable model as the
originating site no longer has to pay for
specialty care
Distant Site:
Contracting with a health plan
allows the specialty group to expand access to
multiple sites, thereby increasing service
volume
Originating Site:
Initial start-up delays in as health plans
are slow to contract with new providers.
Limited to those providers offered
through the health plan
Distant Site:
Health plans will only pay by the
patient seen, which puts the Distant Site at
-risk
for no
-show patients.
On
-demand, 24/7 coverage
(hospital ED, ICU & In
-
patient)
Originating Site
: Guaranteed access and
coverage when needed
Originating Site:
May pay for time that’s not
utilized
Distant Site:
Guaranteed payment for time
reserved
Distant Site
: May provide more services than
originally estimated
Operations
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Define
Policies and Procedures
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Policies and Procedures
• Clinical guidelines
• Referral forms
• Process for patient consent
• Workflow
• Specialty services billing/payment
• Exchanging medical information
• Clinic scheduling
• Patient insurance billing
• Credentialing & privileging
Operations
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Clinical
Policies and Procedures
Clinical
guidelines
for specialty
referral
• GOAL: Provide
enough
information to
make the
process
effective &
efficient
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Process
for
Referral
Request
Clinical
Policies and Procedures
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Process
for
patient
consent
Operations
Policies and Procedures
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Workflow
Operations
Policies and Procedures
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• Clinical guidelines
• Referral forms
• Process for patient consent
• Workflow
• Specialty services billing/payment
• Exchanging medical information
• Clinic scheduling
• Patient insurance billing
• Credentialing & privileging
Operations
Policies and Procedures
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Reimbursement
• State and federal
reimbursement
laws, policies,
legislation and
regulation - visit
cchpca.org
• Contact your
regional TRC, visit
Telehealthresource
center.org
Operations
Policies and Procedures
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Credentialing
& privileging
• Visit
cchpca.org
Operations
Policies and Procedures
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Implement
Technology
Staff Training
Provider Orientation
Community and Patient Education
Go Live with Patient Consults
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• Hardware, software, peripheral equipment
and telecommunications configuration and
testing
Technology
Technology
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• Who should you include in the staff training
process?
– Telemedicine coordinator, clinical staff, technical
staff, billing, coding and compliance staff
• What should be included in the staff training?
– Referral protocols
– Equipment usage and troubleshooting
– Patient presentation techniques
– Coding and billing
– Medical records
– Patient consent
– Process flow
Operations
Staff Training
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• Equipment demonstrations
• Video meet and greet sessions with specialty
providers to discuss referral requirements and
patient presentation techniques
• Place telehealth on the agenda at medical
staff meetings to review patient selection and
process flow
• Multiple mock encounters with debriefing
Clinical
Provider Orientation
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Equipment demo * Appointment fliers * Web site
Operations
Community and
Patient Education
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Operations
Go Live with Patient
Consults
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Improve
Revenue Cycle Analysis
Provider Satisfaction
Organizational Culture
Program Diversity
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• Review and update the financial model based
on the key data points used to establish the
initial pro forma:
– Payer mix of patient population served
– Anticipated volume by specialty
– Estimated payer reimbursement
– Physician compensation and service fees
– Technology platform and recurring infrastructure
costs
– Staffing costs
– Related financial benefits to the facility
Operations
Revenue Cycle Analysis
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• Review claims and payments for potential
areas of process improvement
– Assign a telemedicine lead or expert to own the
process and ensure all codes are entered
appropriately prior to submission
– Mine and analyze all denials received and
continually update the billing policy based on
new payers or change in existing payer policy
• Management reports
– Provide and track monthly productivity, income
and expense reports to show trending over time
Operations
Revenue Cycle Analysis
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• Are your specialty providers getting the
information they need to provide patient care?
• Are your clinical providers getting the
information they need to provide patient care?
• Are your clinical providers satisfied with the
relationship with and services they are receiving
from the specialty provider group?
• Is the technology adequate, reliable and easy to
use?
• Are there any changes to be made to the clinic
flow process?
Clinical
Provider Satisfaction
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Clinical
Organizational Culture
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Operations
Program Diversity
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Repeat the Process
with Every New Initiative
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Resources discussed in this
presentation are available
www.caltrc.org
Needs Assessment
Staff Roles and Job Descriptions
Considerations in Developing Partner Relationships
Contracting Model Pros and Cons
Sustainability Spreadsheet (FQHC contracting model)
Credentialing Guidelines
Billing Guidelines
Sample Referral Guidelines
Patient Consent Forms
Clinical and Operational Workflow Diagrams
Overcoming Integration Barriers
How to Develop a Telehealth Marketing Plan
More!
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The NCTRC Webinar Series
Occurs 3
rd
Thursday of every
month.
Our Next Webinar
Telehealth Topic: CMS 2019 Updates
Presenter: Mei Wa Kwong, JD, Executive Director, Center
for Connected Health Policy
Date: Thursday, February 21, 2019
Time: 8:000AM HST, 10:00AM AKDT, 11:00AM PDT,
12:00PM MDT, 1:00PM CDT, 2:00PM EDT
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• More questions? We’ll be participating in the
Interoperability Showcase, drop by booth 9100-83!
• Please complete online session evaluation!
Questions
Contact Info.
Doris Barta, MHA
Executive Director
National Telehealth Technology
Assessment Center
dtbarta@anthc.org
www.telehealthtechnology.org
Kathy J. Chorba
Executive Director
California Telehealth
Resource Center
chorbak@ochin.org
www.caltrc.org
Jonathan Neufeld, PhD
Executive Director
Great Plains Telehealth
Resource & Assistance Center
jneufeld@umn.edu
www.gptrac.org
www.telehealthresourcecenter.org
@TheNCTRC
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